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Hello, to get started, can you tell us who you are concerned about?
Select A Person...
Myself
Mom
Dad
Wife
Husband
Grandma
Grandpa
Someone else
WHY ARE WE ASKING?
This helps us personalize your assessment. Any information you share is private and secure.
Okay, let's get a handle on where things are today. Where do you live?
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
WHY ARE WE ASKING?
Having an idea of where you live now is important as a starting point. Any information you share is private and secure.
How Old Are You?
Under 55
55-65
66-75
76-85
86-95
Over 95
WHY THIS MATTERS:
Although age and care needs don’t always go hand in hand, many of us may need more support as we get older.
Can you tell us about your currently living situation?
Living at home with no help
Living at home with help from a family member or friend
Living at home with some professional help
Living in a senior living community, with no help
Living in a senior living community that includes help
WHY THIS MATTERS:
This helps us understand if any changes have already been made.
Do you drive?
No
Yes, but I may want to stop
Yes, and I'm not worried about it
WHY THIS MATTERS:
Certain health issues can make driving more risky, while living alone after you've stopped driving can lead to isolation.
Do you get help and care when needed?
Yes, I think so.
Yes, but I think more help may be needed.
No, I don't think so.
I'm not sure.
THINK ABOUT:
Help can come from family, friends, or hired help. When you answer this question, consider (a) do you have access to help, and (b) are you taking advantage of that help?
Alright, now let's talk about why you think it might be time to consider making some changes. You can choose more than one.
It might be time to consider downsizing.
I am curious about home care and senior living community options.
I am thinking about current and/or future care needs.
I am concerned that the current environment is not safe.
I am concerned about loneliness or isolation.
I am feeling a little overwhelmed and could use some help.
WHY THIS MATTERS:
Understanding your motivations can help you find the best options for meeting your needs.
What kinds of daily activities do you enjoy? You can choose more than one.
A walk or other physical activity
Connecting with friends and family
Being with pets
Being outdoors
Spiritual or faith-based activities
TV, movies or music
Quiet time on my own
Other interests or hobbies
WHY THIS MATTERS:
Knowing what you enjoy and care about is important. Maintaining routines, social connections and interests can support your well-being and overall outlook on life.
Do you think you need help with things like meal preparation, housekeeping, and running errands?
No
A little
A lot
I'm not sure
TIP:
These are called Instrumental Activities of Daily Living (IADLs) - things that support living independently. Other IADLs include shopping for groceries or clothes, getting out and about, or using a phone or computer for communication.
Okay, now let's talk about some changes you might have noticed. Do you think that you have lost interest in daily activities?
No
A little
A lot
I'm not sure
WHY THIS MATTERS:
Losing interest in things you once enjoyed can be a sign of depression, or a memory or thinking issue.
Do you think you need help with personal activities, such as getting dressed, bathing and using the bathroom?
No
A little
A lot
I'm not sure
TIP:
You may hear these called Activities of Daily Living (or ADLs) - things we do to care for our body and move around. Other ADLs include feeding yourself, personal hygiene, grooming, and moving from one place to another.
How about staying hydrated? Do you forget to drink water or other beverages?
No
Sometimes
Often
I'm not sure
TIP:
The symptoms of dehydration can be mild, like headaches, or more serious, like confusion and weakness. If you're noticing changes, one of the first things to check is whether you are drinking enough water.
Are you likely to forget the names of friends and family, or how to do things like use the phone, TV, or thermostat?
No
Sometimes
Often
I'm not sure
WHY THIS MATTERS:
Some forgetfulness is a normal part of getting older, but if you notice big changes consider speaking with a doctor. More serious memory issues can create safety concerns.
Is it likely you could wander and get lost in familiar places?
No
A little
Very
WHY THIS MATTERS:
If someone with cognitive or memory issues is prone to getting lost or becoming disoriented, a specialized care setting may be needed.
Are you showing signs of poor judgment?
No
Sometimes
Often
I'm not sure
TIP:
Some examples include choosing inappropriate clothing for the weather, having trouble maintaining appropriate boundaries with other people, or making decisions that seem out of character.
Have you had a recent fall?
No
No, but there is some unsteadiness
Yes
I'm not sure
WHY THIS MATTERS:
Falls are one of the leading causes of serious and costly health issues and hospitalizations.
Do you need help managing and taking medications?
No
Yes
I'm not sure
THINK ABOUT:
Is you able to fill prescriptions on your own? Do you remember to take medication on time? Are you able to follow the dosing instructions, especially if you're taking multiple medications?
Do you need around-the-clock medical or nursing care?
No
Yes
I'm not sure
THINK ABOUT:
If you need 24-hour access to help, think about whether any of your daily needs require medical training. Some health issues need daily or regular medical attention, like injuries, illnesses or chronic conditions. Unlike personal care needs, these types of health issues require access to skilled nursing personnel.
Finally, let's talk about how ready you might be for a change. Would you be open-minded about discussing changes at home, or moving somewhere where more help is available?
Not at all
Somewhat
Very
TIP
This can be a hard conversation. In a moment, we'll share some tips that have helped others talk about this.
How concerned are you about the financial impact of paying for care?
I'm very worried
I'm a little worried - I need help understanding options.
I'm not too worried - we've done some planning.
TIP
Costs can vary widely depending on where you live and what type of care you need. We'll help you understand your options in just a moment.
Do you currently make a monthly housing payment?
Yes, I make a monthly rent payment
Yes, I make a monthly mortgage payment
No, my housing is paid off
There is another arrangement
I'm not sure
GOOD TO KNOW
If you decide to move or downsize, money that is being used for housing can be used for other things. Some families use the sale of a house or property to help with the cost of care.
Do you have access to any programs that can help cover housing and care costs? You can choose more than one.
I am a veteran or the spouse of a veteran
I have long-term care (LTC) insurance
I have or qualify for Medicaid
Something else
None of these
I'm not sure
TIP:
You may be able to use payment options like long-term care (LTC) insurance and VA benefits. A private conversation with a care advisor can help you understand your options.
When you think about this decision, what would make it easier? You can choose more than one.
Having a clearer picture of what life at a senior living community is like
Feeling confident that getting help is the right choice
Feeling confident that it’s the right time to make a change
Feeling confident about my financial situation
Getting everyone in my family on the same page
Something else
I'm not sure
THINK ABOUT:
For most of us this is a big decision, and it’s normal to have questions and concerns. Separating a big decision into several smaller decisions can make it more manageable.
Are you interested in talking with an expert at Courtyard Luxury Senior Living about options that might be a good fit for you?
Yes
Maybe
Not right now
WHAT'S NEXT:
If you're interested in talking to someone at Courtyard Luxury Senior Living, you'll be able to share your contact information and preferences on the next screen.
Ok, someone from Courtyard Luxury Senior Living can reach out with more information. Tell us how to get in touch:
First
Last
Email
Phone
When is the best time to contact you?
Select a time...
Morning
Afternoon
Evening
I would prefer a text
I would prefer an email
TIP:
If you are thinking about options and aren't ready to make a decision, a senior living advisor can answer questions that help you plan for the future.
Finally, are you interested in more information about any of the items below? You can choose more than one:
Pricing & availability
Floor Plans
Calendar of activities & events
Pets
Meals & dining
Transportation
Something else
No, thank you
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